1. Field of the Invention
The present invention relates generally to the field of surgical instruments. More particularly, the present invention relates to the field of surgical instrument apparatuses for holding and cleaning a plurality of surgical instruments used together in a surgery, such as a cautery, a suction device or the like, when not in use and for holding the tube and/or cord attached to the surgical instrument in a predetermined location but permitting movement in response to the surgeon pulling the surgical instrument.
2. Description of the Prior Art
A flexible suction hose is usually used for evacuating blood or other fluids from the surgical wound-cavity during operations on humans or animals. One end of the suction hose is attached to a continuous negative-pressure source located a few feet away from the operating table and sterile operating field. The surgeon's end of the sterile hose is usually fitted with a rigid suction nozzle which is available in different sizes and shapes.
The suction hose is usually anchored to a convenient location on the sterile drapes, such that a loop of the suction hose is formed between the anchorage and the nozzle. The length of the loop of the hose can be adjusted to allow easy reach of the suction tip to all parts of the wound. The hose is usually anchored by wrapping two folds of the sterile drapes around the hose and clamping the folds together with a stainless steel surgical clamp (i.e., Alice clamp, towel clip and etc.). Alternatively, the surgical clamp is attached directly to the drapes and the hose is threaded through one or both finger holes of the clamp handles.
When the suction nozzle is not in use, the suction nozzle is placed on the drapes over the patient, or is placed in a scabbard comprised of an elongated metal or plastic tube container which is closed at one end, or a flat, soft-plastic pocket or sheath, either of which is attached to the sterile drapes by means of a surgical clamp or by adhesive backing.
Suction is provided continuously precluding the need for the surgeon to actuate valves, operate switches and/or the like.
This overall prior art arrangement has many disadvantages. The upper surfaces of the drapes are irregularly convex surfaces and do not provide a secure storage space. The loop of the hose and its nozzle, and other instruments, such as the cautery and its cable, that are placed on this surface have a constant gravitational tendency to slide off onto the floor where they become contaminated and have to be replaced.
Further, although the surgeon may set the loop of tubing and its nozzle down at a point on the drapes that seems secure, the hose is unruly and does not readily remain where it is placed. The hose has a tendency to spring to a different location determined by the stiffness, springiness and other physical characteristics of plastic hose, as well as by the nature and orientation of the hose anchorage. It may thus spring to a less secure location from where it may fall to the floor or it may spring to a location where the surgeon may not readily locate it without taking his or her eyes off the operation.
A hard plastic or metal scabbard, if used is usually anchored to the sterile drapes with a towel clip or other clamp passed through a hole or loop near its upper end. The towel clip often doubles as an anchorage for the vacuum hose by threading the hose through the clamp's finger holes. This provides no control over the direction in which the anchored hose will lie. Also, the nozzle is frequently sprung from the scabbard by the springy properties of the loop of plastic tubing. Also, being anchored only at its upper end, the scabbard is unstable and prone to being upended by the weight of the tubing, thereby causing its contents to be dumped onto the floor. Also, when the nozzle is in the scabbard, a stiff loop of hose between the nozzle and anchor site often protrudes vertically well above the scabbard, where it may get contaminated against the surgeon's mask or otherwise obtrude into the surgeons work space.
If a towel clip or other clamp-like instrument is used to anchor the scabbard or the suction tubing, it can penetrate or tear the sterile drapes. A plastic pocket with a pressure-sensitive adhesive backing is commercially available for housing the suction nozzle, but its adhesive usually does not stick well to the drapes, it is usually too shallow and inserting the nozzle into a flat, collapsed pocket can be somewhat cumbersome.
The surgeon and his team are thus constantly distracted by concern over the hose and nozzle sliding off onto the floor or obtruding into the surgical area or by having to locate the nozzle when needed.
If the hose or nozzle does fall to the floor, the operation has to be interrupted while it is replaced, unnecessarily prolonging the operating and anesthesia time. An attendant may have to leave the operating room to find replacements. The tubing has to be detached from its anchorage and from the vacuum source, and the new tubing and nozzle have to be connected and anchored. The attachment and detachment of the anchoring clamp increases the risk of tearing the drapes and contaminating the sterile field. The lost time and the cost of replaced instruments are additional to the cost of the operation.
The provision of continuous suction without the ability to easily shut-off when not in use has several disadvantages. The suction nozzle creates a continuous, objectionable hissing noise which is distracting and makes for an uncomfortable workplace. Any hard, tube-like scabbard usually amplifies the objectionable sound. Operating room personnel frequently stop the noise by folding the suction hose on itself into a tight loop, thereby closing off the lumen of the hose and jamming the loop into any available suitable space. Alternately, a surgical clamp (hemostat, etc.) is used to clamp off the tubing.
Either method stops the hissing sound, but it takes a two-handed technique to remove the clamp, refold the tube and re-apply the clamp. Also, a clamp adds weight to the tubing rendering it even more likely to upend an unstable scabbard. Suction nozzles are available with a finger-operated on-off valve, but they are inconvenient and are almost never used.
Another problem with prior art, there are residual bacteria in the room air of even the cleanest of operating rooms. The continuous negative pressure of the suction hose, draws a constant flow of room air to and through the tip of the nozzle. The nozzle is frequently dipped into, and it is therefore constantly coated by, blood and other body fluids, which form a sticky bacterial culture medium on the nozzle tip to which bacteria from the constantly flowing air can adhere. These bacteria can be a source of wound infection, either directly when the suction nozzle is reintroduced into the wound or, indirectly when the suction nozzle is housed in the same container as other instruments and comes into direct contact with such other instruments. Having means to easily shut off the suction nozzle when it is not in use would thus decrease the chances of wound infections.
Another problem with prior art is that the suction hose is usually connected via a series of canisters to other suction hoses in use in the same operating room, either to add suction lines used by the surgeon or to a separate suction line used by the anesthesiologist for suctioning secretions from the patient's throat. When multiple hoses are in use in the same operating room, they siphon off negative vacuum pressure from each other, mutually decreasing the suction efficiency of all the lines in use.
The vacuum lines from each operating room in a suite of multiple operating rooms are usually interconnected via a central vacuum pipe connected to a central vacuum pump. The negative pressure lost through any open vacuum hose reduces the strength of the vacuum to other vacuum hoses in the same operating room or in other operating rooms fed by the same system. Occluding suction hoses that are not in actual use therefore increases the general efficiency of the suction system in the entire operating room suite.
A further problem with prior art devices is that the tip of the suction nozzle frequently becomes clogged with soft tissue or bone fragments. The surgeon has to pry the blockage with a long narrow needle-like instrument to dislodge the blockage. Most often the tip of the cautery is used, but it is usually too short or too thin, and the tine of a hemostat is usually too thick, short and curved for dislodging the blockage. In addition, both methods require two hands to perform the dislodging maneuver.
The pencil-like cautery and its flexible cable share many of the problems encountered with the suction hose and its suction nozzle. Its cable must have anchorage, and the device and its loop of cable are also often laid on the drapes over the patient, thereby having a similar tendency to fall to the floor. Many suppliers package it with a small hard-plastic scabbard which is clamped to the drapes with a towel clip, rendering the scabbard unstable as noted above.
A flat soft plastic pocket is commercially available. It is secured to the drapes by a pressure-sensitive adhesive. The main disadvantage is that its thin wall and hence the underlying drapes are susceptible to penetration by the sharp tip of the cautery, with the potential for contamination or injury to the patient's underlying skin by sharp penetration, electric or thermal injury. The pocket is usually in a collapsed state which can make insertion of an instrument cumbersome.
Frequently, the scabbard used for the suction nozzle doubles as a holder for the cautery, where the suction hose and cautery line frequently become entangled. The close proximity of the two instruments increases the risk of bacterial cross-contamination and the combined weight adds to the tendency for the scabbard to upend, dropping both the instruments on the floor. For these reasons it is desirable to have separate holders for the cautery and the suction nozzle.
The cautery has an additional problem in that its flat, paddle-like metal electrode often becomes caked with charred tissue rendering it less conductive and therefore less efficient. A small swatch of abrasive paper is commercially available for cleaning the tip. It is applied to the surgical drapes by means of an adhesive backing. These swatches have the disadvantage of being flat so that only the tip of the electrode can be cleaned unless the surgeon takes the two-handed method of bending the electrode to an angle to present a flat surface parallel the flat swatch and then having to bend the electrode in the opposite direction to clean its other side in a similar manner and then having to straighten out the bent electrode.
Surgeons repeatedly use many other surgical instruments. These surgical instruments are often placed on the irregular upper surfaces of the drapes which cover the patient. Some of these surgical instruments are expensive and fragile and some have attached fiber-optic or electrical cables. Therefore, some means is required for securing and reliable retention of these instruments, as well as for anchorage their fiber-optic cable or other extensions.
U.S. Pat. No. 3,128,072 issued to Shibata on Apr. 7, 1964 discloses an article attaching device which includes a back member. The back member comprises a film of a flexible synthetic resin and a back surface which is coated with an adhesive agent. The adhesive surface is applied with an easily removable separator such as paper coated with a parting agent or cellophane.
U.S. Pat. No. 3,696,920 issued to Lahay on Oct. 10, 1972 discloses a device for organizing objects. It comprises a block of a semi-rigid foam which has a plurality of channels of a configuration adapted to retain the object therein, a beveled slot providing communication between the surface of the block and the channel, the width of the slot narrowing as it approaches the channel, and means for adhesively securing an outer surface of the block to a suitable supporting surface. The object is inserted through the beveled slot into the channel where it is retained in a locked position until needed. The object is then removed for use from the channel by expanding the slot sufficiently to permit the object to be withdrawn from the channel through the slot. The device only anchors tubes, cables or cords and provides no directionality to the secured object.
U.S. Pat. No. 4,074,397 issued to Rosin on Feb. 21, 1978 discloses a disposable device for securing cords, tubes, and the like during surgical or other medical operations. The device may be fastened to the paper or fabric sheet which covers the patient during surgery. The device comprises a thin, flexible pad that has a pressure-sensitive adhesive layer on one side so that it may be removably attached to the aforesaid sheet. It also has an elongated flexible strip portion integral with the pad. The strip portion is wrapped around the cord or tube to be secured by the device and anchored by a VELCRO®. The device only anchors tubes, cables or cords and provides no directionality to the secured object.
U.S. Pat. No. 4,174,816 issued to Olson on Nov. 20, 1979 discloses a sterile surgical cord and tube retractor. The device includes a housing adapted to be supported on the instrument table positioned adjacent the surgical filed. A plurality of spring-tensioned retractors within the housing separately hold lengths of tubing and cord, permitting them to be withdrawn from the housing for use and then retracted back into the housing.
U.S. Pat. No. 4,417,710 issued to Adair on Nov. 29, 1983 discloses a combined surgical instrument and tube holder device. The device is provided for yieldably supporting a hose and/or cord extending from a surgical instrument. The device includes a pad which is adhesively securable to a surgical drape or other surface and is connected to a releasable hose holding means by a stretchable member. The hose holding means includes a strip having a foam layer on one side and a fabric layer of intertwining material on the other side and a tab attached to one end of the strip and having an interlocking surface which releasably adheres to the fabric layer so as to hold the hose and/or cord in desired location while allowing them to move in response to movement of the surgical instrument. In one embodiment, the outer side of the pad has a layer of intertwining material and a strip of interlacing material is adhesively attached to the surgical instrument so that the instrument can be nested on the pad by pressing the interlacing material against the intertwining material on the pad.
U.S. Pat. No. 4,793,483 issued to Holmes on Dec. 27, 1988 discloses a tray for surgical patties. The tray is made of metal and is held to the drapes by means of alligator clips. Holders on the outer edges of the tray are provided for holding an electric cautery, cutter and forceps.
U.S. Pat. No. 5,102,399 issued to Chu on Apr. 7, 1992 discloses a clinical tube holder valve assembly and method. The holder assembly has a tube-receiving passage attached to a mounting block and a pressure-sensitive adhesive thereon for selectively mounting the suction tube holder. A portion of the fluid-flow tube is selectively folded on itself and inserted into the tube-receiving passage for being held therein at a fixed location with a blocked lumen.
U.S. Pat. No. 5,160,106 issued to Monick on Nov. 3, 1992 discloses an adaptor for anesthesia equipment. The apparatus comprises a support member for suction tubing and a catheter, means for clamping the support member to the operating room table and a passageway through the support member for receiving one end of the suction tubing. A catheter is provided which has one end for insertion in the patient's mouth and the other end for connection to one end of the suction tubing. Connection means is provided with one end of the suction tubing for preventing the catheter from passing through the passageway. The passageway is constructed and arranged so that the tubing can be pulled up through the support member to permit the catheter to reach the mouth of the patient and when released will slide back down and stop at the catheter so as to be readily available for reuse. A clamp is carried by the support member for clamping and unclamping the suction tubing and for controlling the suction through the suction tubing to the catheter. The support member has a portion which is shaped to receive a bar on the operating room table and means for clamping the support member to the operating room table. The clamping means comprises a screw member threadedly carried by the support member and one end adapted to engage the bar. The passageway through the support member includes a wall structure which provides low friction with respect to the suction tubing to be pulled therethrough. The passageway through the support member includes a tubular sleeve which has an inner surface for providing low friction with respect to the suction tubing when pulled therethrough.
U.S. Pat. No. 5,334,186 issued to Alexander on Aug. 2, 1994 discloses medical tubing and implement organizer. It allows medical implements to be held in a convenient location proximate to a patient and also allows the medical tubes to be organized and ordered according to size. The tubes are in generally cylindrical lateral bores.
U.S. Pat. No. 5,533,618 issued to Pickels, Jr. on Jul. 9, 1996 discloses a surgical holster for organizing hoses. The hoses are held in generally cylindrical lateral bores in the tubing holder. The hose holding portion of the device is demountably attached to the flat base portion.
U.S. Pat. No. 6,431,500 issued to Jacobs et al. on Aug. 13, 2002 discloses a flexible tube or cord anchoring apparatus which includes a base and a securement member. A cover is attachable at the base and includes a raised shield section which has an access opening. A mounting material layer is affixed at an opposite surface of the base for selected location and securement of the apparatus. In use, the hose or cord is releasably receivable at the securement member through the access opening at the shield section of the cover, where the securement member and the hose or cord received therein being recessed relative to the shield section.
U.S. Pat. No. 6,575,298 issued to McArthur et al. on Jun. 10, 2003 discloses a surgical instrument holder which includes a holder body with connecting adjacent elongated cylinders. The cylinders are able to hold a plurality of surgical instruments such as a diathermy pencil and suction means, or two laparoscopic instruments or the like, and allow easy removal of the instruments.
U.S. Pat. No. 3,982,357 issued to Eldridge et al. on Sep. 28, 1976 discloses a cleaning device for cautery. It includes a supporting frame adapted to be attached to a towel or drape used in surgery and held by an atraumatic clip. The frame has a pair of abrasive strips having mutually engaging surfaces provided with diverging entrance ends for a cauterizing knife to be inserted thereto.
U.S. Pat. No. 6,021,540 issued to Miller et al. on Feb. 8, 2000 discloses a tip cleaner for operating room instruments. It includes a base, upstanding bristles, at least one sharp vertical edge and a flat top.
It is highly desirable to have a very efficient and also very effective design and construction of a disposable surgical holder and cleaner apparatus which can securely retain surgical instruments when not in use during surgery, but allow easy removal of surgical instruments when they are required during surgery. In addition, the apparatus also provides means for easily shutting off the suction nozzle when not in use, de-clogging the tip of the suction nozzle as needed and scraping char off the tip of the cautery instrument, all with a one-handed technique.